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Porcelain Gallbladder
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
The term ‘porzellangallenblase’ (porcelain gallbladder) was proposed by Heinrich Florcken1 (Frankfurt), in 1929, to denote the changes seen in an inflammatory condition that caused calcification of the gallbladder wall. It was presumably meant to emphasize ‘the brittle consistency and bluish discoloration of the wall’2. Although Florcken considered it to be the result of a previous inflammatory process and of no consequence, other cases were soon reported that disputed its supposed innocuous nature3. These gallbladders may function poorly and often contain gallstones. Gallbladder carcinoma, a relatively uncommon gastrointestinal tract malignancy, has an increased incidence in cases of porcelain gallbladder. The pattern of calcification in the gallbladder wall is important when one is considering the possibility of carcinoma (Figure 1). ‘Incomplete calcification of the wall is much more likely to be associated with [gallbladder carcinoma] than the complete type.’4 This is likely to be due to the fact that with complete calcification the mucosal epithelium is totally replaced by dense connective tissue that is not prone to undergo a cancerous change. Ultrasound and computerized tomography can also be used to detect and evaluate porcelain gallbladders. A giant gallstone is one plain film mimic that also has been reported to have an association with the development of a gallbladder carcinoma.
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
This is generally associated with gallstones and may follow acute cholecystitis or develop insidiously. There may be superimposed acute cholecystitis. The gallbladder is thickened and fibrotic muscle fibres are hypertrophied. The mucosal epithelium may be atrophic or hyperplastic, sometimes forming diverticula which can reach the serosal surface (these diverticula are often called Rokitansky–Aschoff sinuses). The presence of cholesterol and bile in damaged diverticula stimulates a xanthogranulomatous response, with large numbers of foamy histiocytes and multinucleated foreign body giant cells containing cholesterol crystals. Severe chronic cholecystitis often causes fibrosis of the gallbladder bed, so that the inflamed organ is firmly adherent to the liver and difficult to remove. Diffuse calcification of the gallbladder wall, known as ‘porcelain gallbladder’, may rarely occur.
The Gallbladder and Bile Ducts
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
A plain x-ray may also show the rare cases of calcification of the gallbladder, a so-called ‘porcelain’ gallbladder (Figure67.4) . This is more commonly seen on computed tomography (CT) (Figure67.5). Traditionally, this has been considered an indication for cholecystectomy as it was associated with a high incidence of gallbladder carcinoma. However, contemporary data suggest that this may not be the case, with the true incidence of cancer being less than 5%. Therefore, decisions on whether or not a cholecystectomy should be performed should be individualised depending on the age of the patient, comorbidities and presence or absence of symptoms.
Emerging treatment strategies in hepatobiliary cancer
Published in Expert Review of Anticancer Therapy, 2023
Deniz Can Guven, Hasan Cagri Yildirim, Elvin Chalabiyev, Fatih Kus, Feride Yilmaz, Serkan Yasar, Arif Akyildiz, Burak Yasin Aktas, Suayib Yalcin, Omer Dizdar
Biliary tract cancers (BTC) include intrahepatic cholangiocarcinoma (iCCA), hilar cholangiocarcinoma, extrahepatic cholangiocarcinoma (eCCA), and gallbladder cancer (GBC) [1]. Although they are grouped together as biliary tract cancers, these four entities have distinct characteristics regarding the epidemiology, risk factors, tumor molecular characteristics and prognosis [2]. The gallbladder cancer is more frequent in women in advanced ages. Majority of the patients are incidentally diagnosed after cholecystectomies for benign reasons. Symptomatic patients with GBC tend to have poorer overall survival due to the higher frequency of local and vascular invasion, regional lymph node involvement, and distant metastases at the time of diagnosis [3]. Obesity, gallstones with chronic inflammation, calcified gallbladder (porcelain gallbladder), polyps of 1 cm and above, primary sclerosing cholangitis, and inflammatory bowel diseases are other risk factors [4]. The median overall survival rates for stage I–III and IV disease are 12.9 and 5.8 months, respectively [5]. The prognosis is poorer and the frequency of targetable alterations like fibroblast growth factor receptor (FGFR) and isocitrate dehydrogenase (IDH) gene mutations is lower in patients with GBC compared to iCCA [6].
Malignancy in elective cholecystectomy due to gallbladder polyps or thickened gallbladder wall: a single-centre experience
Published in Scandinavian Journal of Gastroenterology, 2021
Dennis Björk, Wolf Bartholomä, Kristina Hasselgren, David Edholm, Bergthor Björnsson, Linda Lundgren
Gallbladder polyps are due to an elevation of the gallbladder mucosa, which protrudes into the gallbladder lumen. Polyps can be divided into polyps and pseudopolyps. Pseudopolyps have no malignant potential and thus require no further intervention or follow-up. Polyps, including those classified as adenoma and adenocarcinoma, warrant surgical resection. The occurrence of gallbladder polyps among adults has been estimated to be 5%, and of these, 5–30% are considered true polyps [7,8] (Figure 1). Features that predict malignant disease include the following: polyp size ≥ 10 mm, solitary or sessile mass, associated gallstones, patient age over 50 years, rapid polyp growth, primary sclerosing cholangitis and positive fludeoxyglucose (FDG) uptake on positron emission tomography (PET) [2,8–10]. For patients with primary sclerosing cholangitis, surgical intervention is recommended regardless of polyp size, as even small polyps have been shown to carry malignant potential in this patient group [1,8,11]. Ethnicity and geography are also factors to consider, as a higher incidence of gallbladder cancer is observed in Latin America and Asia and a lower incidence is observed in the United States and in Western and Mediterranean Europe [2,12,13]. Gallbladder wall thickening can consist of adenomyomatosis, chronic cholecystitis and porcelain gallbladder (Figure 2).
Method for adequate macroscopic gallbladder examination after cholecystectomy
Published in Acta Chirurgica Belgica, 2020
Bartholomeus J. G. A. Corten, Wouter K. G. Leclercq, Peter H. van Zwam, Rudi M. H. Roumen, Cees H. Dejong, Gerrit D. Slooter
There are several abnormalities associated with an increased risk for gallbladder cancer (GBC). Primary Sclerosing Cholangitis (PSC) has been associated with increased risk of developing gallbladder cancer [17]. The estimated lifetime incidence of GBC in patients with PSC is 3–14% [18, 19]. Some studies show that 5–28% of patients with initial presentations of Mirizzi-syndrome turned out to contain GBC [20,21]. Other macroscopic gallbladder abnormalities include: porcelain gallbladder (Figure 4(a,b)), metastasis or the very rare neuroendocrine neoplasm of the gallbladder. The latter two are macroscopically indistinguishable from gallbladder carcinoma (Figure 4(c–g). All above mentioned abnormalities should undergo additional histopathology in search of malignancy.